IN THIS LESSON

Extension Type: Distal fragment is displaced posteriorly

Flexion Type: Distal fragment is displaced anteriorly

Extension

Proximal Humerus Fractures

  • Mechanism: Often due to falls or sports injuries.

  • Growth Plate: Involves the physis (Salter-Harris fractures).

  • Remodeling Potential: Very high, especially in young children.

  • Treatment:

    • Non-operative (sling or Sarmiento brace) for most.

    • Surgery (e.g., closed reduction with percutaneous pinning) if significantly displaced in older children or adolescents.

Flexion

Humeral Shaft Fractures

  • Mechanism: Falls, high-energy trauma, or birth injuries (e.g., clavicle or humerus fractures during delivery).

  • Presentation: Obvious deformity, swelling, arm held still.

  • Treatment:

    • Most heal well with immobilization (hanging arm cast or u-slab splint).

    • Rarely need surgery unless polytrauma or open fracture.

  • Complication: Radial nerve palsy (usually neuropraxia, recovers spontaneously).

Distal Humerus Fractures

  • Most commonly supracondylar fractures.

  • Mechanism: Fall on outstretched hand (FOOSH)

  • Subtypes:

    • Extension-type (95% of the time)

    • Flexion-type

  • Classification: Extension types are classified by the Gartland classification system. They include Gartland types I–IV. Flexion type fractures are a rare kind of fracture.

  • Treatment:

    • Type I: immobilization

    • Type II: often closed reduction and casting or pinning

    • Type III: usually require closed or open reduction and percutaneous pinning (CRPP or ORIF)

    • Flexion Type: CRPP or ORIF

  • Complications: Neurovascular injury (anterior interosseous nerve for extension type and ulnar nerve for flexion), compartment syndrome, cubitus varus

Types of Nonoperative Treatment- Definitiions:

From left to right: u-slab splint, hanging arm cast, sarimento Brace

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    7. Thomson JE, Edobor-Osula OF. Do Pediatric Shoulder Fractures Benefit From Surgery?Curr Opin Pediatr. 2021;33(1):97-104. doi:10.1097/MOP.0000000000000979.

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    9. James V, Chng ACC, Ting FLM, Chan YH, Ganapathy S. Lateral Condyle Fracture of the Humerus Among Children Attending a Pediatric Emergency Department: A 10-Year Single-Center Experience. Pediatr Emerg Care. 2021;37(12):e1339-e1344. doi:10.1097/PEC.0000000000002032.

    10. Hohloch L, Eberbach H, Wagner FC, et al. Age- And Severity-Adjusted Treatment of Proximal Humerus Fractures in Children and Adolescents—a Systematical Review and Meta-Analysis. PLoS One. 2017;12(8):e0183157. doi:10.1371/journal.pone.0183157.

    https://radiopaedia.org/articles/cubitus-varus?lang=us